More on Treating Social Anxiety: A Process-Experiential Alternative to Assertiveness Training

Entry for 16 September:

In our email and lunch exchanges on the Social Anxiety Project, Mick Cooper also suggested adding assertiveness training, following the pluralistic approach he and John McLeod have been pursuing. I’m afraid that is a bridge too far for me, however: I believe that adding such as content directive intervention, in which the therapist sets out to “teach” the client new behaviors is neither necessary nor consistent with a person-centered/process-experiential (PCE) approach.

Instead, PCE therapists believe that clients generally have the ability to express their needs in their relationship, but choose not to do so for various reasons. This often involves self-interruptive processes in which an adaptive emotion or associated action tendency is stopped by a critical or censoring aspect of self. The therapist’s job is to help clients to explore and decide whether they want to remove these self-interruptive blocks.

In rare instances, the client may lack the skills in the first place because they never learned them in the first place; here, the therapist’s job is to provide the client with a task environment in which they fee safe enough to develop these skills through active exploration of their emotions, and associated wishes and action tendencies. For example, assertiveness is most effectively learned through helping the client access their adaptive anger, overcome their self-interruption of this anger (through the Two-chair Enactment task), identify the needs that are connected to the anger (e.g., self-protection from physical harm or exploitation by others), and explore different ways of getting those needs met. While the PCE therapist would not advise the client to go out and try to use the strategies generated in this way, they might encourage the client to pay attention to times during the week when they felt the same emotions and note what comes up inside when they try to get their needs met. Also, the therapist would support the client in their attempts to develop ways of getting their needs met.

However, a behavior therapist would say that using chair work in which the client dialogs with their projected critic or significant other is actually assertiveness training. I prefer to say that the client is working with their emotion schemes of the shaming or critical other and trying to access their adaptive/assertive anger or sadness. The difference is that I am not trying to get the client stand up and assert themselves, for various reasons, including the fact that clients often have good reasons for not expressing anger or demands to important others and those are important to understand and respect. My pluralism has limits and applies more outside my therapy room, i.e., it is more about respecting other perspectives than about integrating them into my own.